evaluation of a hand carried cardiac ultrasound device in an outpatient cardiology clinic - lithium ion rechargeable battery

Objective: to determine the diagnostic potential of ultrasound in the back of the hand heart (HCU)device (
Philips Medical Systems
In the heart disease clinic, HCU diagnosis and clinical diagnosis were compared with a fully functional standard ultrasound heartbeat (SE)system.
Methods: 300 patients were enrolled in the study.
HCU examination was performed by experienced ultrasound cardiologists before the patient's visit.
The ultrasound heartbeat inspectors noted whether the HCU equipment was able to confirm or reject the referral diagnosis, what abnormalities were detected, and whether it was necessary to conduct an SE survey.
The cardiologist then performed a physical examination, and thereafter, a complete study of the SE was conducted whenever needed.
HCU data were compared with clinical diagnosis and blind SE diagnosis by cardiologists.
Results: Of the 203 patients, 300 were enrolled in the SE study, and 13 were examined by esophageal ultrasound.
Of the 84 patients, no further examination was deemed necessary.
HCU heartbeat maps can confirm or reject suspicious clinical diagnosis in 159 of 203 (78%)patients. In 44 of 203 (22%)
Patients need to do heart color Doppler ultrasound.
The consistency of detecting major anomalies between HCU devices and SE systems is very good (98%).
The HCU unit missed 4% of the main findings.
Of the 84 patients who did not refer to SE, HCU devices detected unsuspected significant abnormalities in 14 patients (17%).
Conclusion: the integration of HCU equipment with physical examination increases the yield of information.
Physical examination is the cornerstone of evaluating referral patients in outpatient heart disease clinics, but it often fails to provide conclusive diagnosis.
Since the introduction of the ultrasound heartbeat and Doppler, the limitations of physical examination for specific cardiac abnormalities have been shown, especially in the early stages.
1 In addition, due to the existing time pressure and increasing availability and dependence on more complex imaging methods, the auscultation skills and experience of auscultation experts have declined due to the fact that there is less training in the curriculum.
Therefore, ultrasound heartbeat and Doppler are initial diagnostic tests in most patients.
In practice, most of these tests were conducted a few days after the first patient and doctor met, resulting in a delay in the final diagnosis and sometimes a delay in treatment.
Recently, small hands carry heart ultrasound (HCU)
The device has become available and initial studies have shown that it is effective to diagnose heart abnormalities directly at the point of care.
6, 7, 8, 9, 10 HCU examinations can distinguish between normal and abnormal conditions and identify patients with severe cardiac abnormalities that can be missed by a separate physical examination.
The purpose of this study is to determine the diagnostic potential of HCU equipment in patients who first visit an outpatient heart clinic (new patients).
HCU diagnosis was compared with the physical examination diagnosis and the standard ultrasound heartbeat diagnosis with complete functions of cardiologists (SE)examination.
Materials and methods in the study population and design in five months, 300 new patients in the thoraxcenter clinic in Rotterdam received an experienced ultrasound heartbeat test (cardiologist)
Before the patient's first visit to a cardiologist
The patient's features are listed in Table 1.
A referral diagnosis was performed by an ultrasound cardiogram examiner and the patient was sent to a cardiologist.
She made a short history and conducted an HCU check (
Maximum duration of 10 minutes)
And noted her findings as well as qualitative assessment and quantitative results.
She then noted whether further ultrasound and Doppler examinations were needed with SE.
Subsequently, a cardiologist was consulted to examine the patient who did not know the HCU assessment and decided whether to use the SE system for an ultrasound (
Sonos 5500, Philips Medical Systems, Eindhoven, Netherlands;
Or System 5 (Norway, Netherlands, Netherlands)was indicated.
Then the independent ultrasound heartbeat examination (sonographer)
Who turns a blind eye to HCU results?
Cardiologists who did not participate in the study explained the results of the SE examination.
ECG for routine clinical practice was recorded in all patients.
The doctor's clinical diagnosis is based on the combination of clinical medical history, physical examination and ECG results.
The institutional medical ethics committee approved the study and received informed consent from all patients.
View this table: View baseline features of 300 outpatients with heart disease
Philips Medical System
HCU equipment is used (fig 1).
It is equipped with a 2.
5 MHz phase array broadband converter working on rechargeable lithium-ion batteries or AC.
The system also integrates two-dimensional imaging, color Doppler imaging and two calipers for linear measurement.
The image is recorded on the CompactFlash card.
Download figureOpen in Figure 1 of the new tabDownload powerpoint. OptiGo equipment, manual cardiac ultrasound (HCU)
Equipment used in research.
The diagnosis of cardiac vascular abnormalities in HCU devices is divided into large or small.
Significant abnormalities are considered clinically significant abnormalities that can trigger further diagnostic evaluation, change or start treatment management, or have prognostic significance (table 2).
Minor abnormalities are considered to be abnormalities that have no clinical significance and therefore do not affect decision-making in patient management.
View this table: Pulse and continuous wave Doppler patterns of SE were used to evaluate major cardiovascular valves or flow anomalies detected using HCU devices.
The severity of these anomalies is graded according to the standard method.
No major abnormalities were found (
The definition of "Main" is shown in Table 2)
It is considered to be a major abnormality detected by the ultrasound heartbeat, which has not been reported in history, has not been suspected, and has not been described from the patient's symptoms.
In addition, these abnormalities were not found in the medical examination of cardiologists.
Statistical analysis reports descriptive statistics as average (SD)
For the percentage of continuous variables and classification variables.
The consistency between the two inspection techniques for detecting major anomalies was assessed from 2 × 2 weighted k statistical tables.
K value 0.
75 people were considered poor, fair and good agreements, respectively.
12 results general results stable 3 300 patients sent to the heart clinic by primary care doctors raised the most common referral problem or suspected diagnosis.
After the physical examination, the cardiologist asked 203 of the 300 patients to undergo an ultrasound (68%)patients.
Table 3 also lists the most common referral issues or suspected clinical diagnoses of these 203 patients requiring SE.
13 of 300 (4%)
The patient was sent to an esophageal study to assess the source of the heart of the embolism.
84 years in 300 did not require further review (28%)patients.
View this table: see the reason why the inline View popupTable 3 u2003 primary care physician and cardiologist recommend, the cardiologist sent SE. HCU examination was able to confirm or reject the 159 cardiologist in 20378%)patients.
For example, the clinical diagnosis of suspected left heart (LV)
In the absence of the need for SE, the mast can be easily and reliably confirmed or rejected through the HCU check. 8In 44 of 203 (22%)
The HCU device was able to confirm or reject the clinical diagnosis, but the evaluation of blood flow Doppler was considered necessary.
Since this feature was not present in HCU and SE examinations, the following findings were subsequently evaluated: Severity of valve stenosis (14 patients);
Valvar antigastric lesions (10 patients);
Comfort LV function (four patients);
LV outflow obstruction (seven patients);
Congenital abnormalities (six patients);
Evaluation of artificial valves (three patients).
It is worth noting that valvar or congenital lesions were detected in all of these patients and that HCU devices can roughly estimate their severity.
The cardiologist who did not send the SE did not mention 84 of the 300 (28%)
Patients studied by SE. In 17% (14 of 84)
Among these patients, a major unsuspected abnormality missing from the physical examination was detected with HCU equipment.
In addition, no abnormality was detected by the HCU device in 17% (14 of 84)
And minor abnormalities in 66% (56 of 84).
The HCU ultrasound map indicates that SE examination is required for 14% (12 of 84)
In this group of patients, because the Doppler pattern is required (
3 patients from groups where no major abnormalities were found).
A total of 217 patients with major and minor abnormalities detected by HCU devices and SE systems performed SE examinations.
The cardiologist referred 203 patients and the HCU examiner independently referred 14 patients.
The consistency of the two devices to detect major abnormalities is very good (98%, κ u200a=u200a 0. 95)(table 4).
Table 5 lists the abnormalities detected by the SE system and those missed by the HCU equipment and physical examination.
There are six major abnormalities missing from the HCU device: a small ventricular defect located at a high level and two aortic stenosis (
Moderate with a peak gradient of 40mm Hg and moderate with a peak gradient of 25mm Hg)
In the same patient with poor echo window, moderate lobe and aortic closure were incomplete and moderate LV dysfunction.
View this table: View the inline View pop-up table 4 agreement for detecting major abnormalities in 217 patients between agreement OptiGo and the standard ultrasound heartbeat system View this table: view inline View pop-up table 5 Detection of secondary and primary cardiovascular findings in 203 patients undergoing SE examination figure 2 A brief overview of the correlation system for primary and secondary findings between HCU devices and SE.
Download the protocol between the heart ultrasound on the back of the hand in figure 2 of the new tabDownload powerpoint (HCU)
Equipment and standard ultrasound (SE)
System 98% (κ u200a=u200a 0. 95).
HCU found 14 major unexpected abnormalities in 84 people (17%)patients.
* Absolute number of abnormal patients;
The discovery of esophageal ultrasound (TOE)examination;
Of the 84 patients whose cardiologists did not mention the ultrasound, 14 patients with significant abnormalities in HCU were examined for SE after the HCU ultrasound.
Of the 300 patients, 71 major unsuspected findings were detected by the ultrasound heartbeat (20%).
Importantly, of these 71 findings, 14 out of 84 were 15 (17%)
The cardiologist did not mention the patients with SE.
In particular, these judgments determine left ventricular thickeningsix patients)
, Fatty blocked heart disease (one patient)
LV dysfunction or abnormal Wall movement (three patients)
, Valvar return (two patients)
, Expanding the ascending aorta (one patient)
Deformity of the second tip (one patients)
Effusion of the heart (one patient).
Two of the findings were found in the same patient.
Three patients required SE Doppler examination for gradient assessment after HCU examination.
One patient was diagnosed as the main artery stenosis by physical examination.
The main findings of 71 unsuspected items are as follows: lvh (28 patients)
, Valvar return (20 patients)
Narrow Valvar (six patients)
LV dysfunction (five patients)
, Heart disease (four patients)
And Miscellaneous (eight patients).
Figures 3, 4 and 5 show examples of major unsuspected findings detected with HCU devices and verified through the SE system.
Download figureOpen to download the off-section view of a 48-year-old ascending aortic expansion patient in the new tabDownload powerpoint Figure 3 (42 mm).
The patient had a history of palpitations and was referred to an outpatient cardiology clinic to assess recurrence of the loveral section
Enter the heartbeat.
Download figureOpen in new tabDownload powerpoint figure 4, a half-axis view of a 46-year-old woman with a history of cancer.
She was assessed before surgery.
The left ventricular end diameter was 69mm.
The estimated shooting score was